HEEADSS Assessment:

Guide on Adolescent-
specific History Taking

NIKKI IRENE C. YTANG, RN

Adolescent Health and Development Program
Coordinator
City of Bogo Health Office
 Learning Objective:
 The participants shall learn to identify the
common Risk Behaviours among adolescents;
how to conduct HEEADSS Assessment to
identified risky adolescents and what to do about
it.
 HEEADSSS Assessment
 H – Home
 E – Education/Employment
 E – Eating
 A – Activity
 D – Drugs
 S – Sexuality
 S – Safety
 S - Suicide
 Risk Behaviors of Adolescents in
the Philippines
 Majority of the youth mature successfully
through adolescence without apparent long term
problems. All adolescents should be considered
at risk due to the prevalence of risk behaviors,
the inherent developmental needs of
adolescents, and the various risk factors for
their initiation and maintenance.
 Risk Taking
 Defined as participation in potentially health
compromising activities with little understanding
of, or in spite of an understanding of, the possible
negative consequences.
 ACTIVITY 1: Identifying of Risk
Behaviours among Adolescents
 Materials Needed:
1. Manila Paper
2. Markers
 Instructions:
- Divide the participants into groups.
- On the Manila Paper provided, draw a representation of
an adolescent.
- Discuss among the group the common Risk Behaviours
among adolescents and write it on the Manila Paper as
well.
- Present group output by assigning a presenter/s.
 The Department of Health, in its Adolescent and
Youth Health Policy (2000), has identified the
following health risks: substance use,
premarital sex, early childbearing, abortion,
HIV/AIDS, violence, accidents, malnutrition,
and mental health.
Trouble Signs in Adolescence
 Sexual promiscuity
 Regular use of drugs and alcohol
 Repeated violation of the law or school
regulation
 Running away more than once in 3 months
 Skipping school more than once in 3 months
 Aggressive outbursts/Impulsiveness
 Dark drawings or writings
 Deterioration in hygiene
 Oppositional behavior
 Refusal to work/non compliance
 Chronic lateness
 Falling asleep in class
 Changes in physical appearance
 Excessive daydreaming
 Statistics
Key facts
 Over 1.5 million adolescents and young adults aged 10–24 years died in
2021, about 4500 every day.
 Young adolescents aged 10–14 years have the lowest risk of death among
all age groups.
 Injuries (including road traffic injuries and drowning), interpersonal
violence, self-harm and maternal conditions are the leading causes of
death among adolescents and young adults.
 Half of all mental health disorders in adulthood start by age 14, but most
cases are undetected and untreated.
 Early onset of substance use is associated with higher risks of developing
dependence and other problems during adult life, and people of younger
ages are disproportionately affected by substance use compared with
people of older ages.
 Globally, there were 42 births per 1000 to girls aged 15–19 years in 2021.

Source: World Health Organization April 2023

 Organizing an Adolescent-friendly
Room
 A place wherein an adolescent can freely express
her opinions and emotions, away from
judgement, and offers a sense of acceptance,
guidance and relief.
 Characteristics
 Accessible – should be located in a place where
adolescents can access its services (like inside or
near school)
 Acceptability
- Viewing the adolescent as the primary patient.
 Appropriateness

- Provides understanding of the client’s situation

and equitable solutions
 Do’s
 Ensure that the consultation are done in a place
where the interaction between the adolescent and
the provider cannot be heard by anyone else.
 Maintain records in such a way that they can be
retrieved quickly and also that no unauthorized
person has access to it.
 Provide comfortable seating with proper
ventilation, good lighting and
reading/information materials.
 Ensure that no interruption occurs when a
consultation is in progress. (like phone/text calls,
signing papers, etc.)
 Ensure that no needless delays occur.
 Ensure that the adolescent is clear about what to
do (e.g. providing clear instructions as to where
to go for a test and when to come back for the
results)
 Tips on how to deal with adolescents
(and their accompanying adults)
 Greet the adolescent in a friendly manner. You
may stand up from behind your desk and sit
facing the patient.
 Explain the issue of confidentiality to both the
adolescent and the parent. Assure them that you
will not share any information that they have
trusted you with, unless they give you permission
to do so.
 If the parent is with the adolescent, entertain their
concerns and allow them to verbalize this. Get all
general data that may be needed from the parent
– like family history, past history, developmental
history, and immunization history. Avoid
assumptions that the adult accompanying the
adolescent is the parent. Always clarify this
point.
 Inform the parent that you will now interview the
patient alone and that you will call them back to
discuss your assessment and plans.
 The parent should not feel isolated. Assure them
that interviewing the adolescent alone is not a
reflection of them as parents.
IN SITUATIONS WHERE…
• The adolescent feels shy and awkward
• The adolescent is angry
• The adolescent is distrustful
• The adolescent is quiet and
uncooperative
YOUR STEPS WILL BE…
• Reassure the adolescent and start the
interview with general questions and
comments to break the ice. Help them
relax.
• Earn their trust and show them you are
really interested in helping them. Be
honest and less authoritative. Avoid
playing the role of a parent.
• Be friendly but do not behave and talk
like a teen. You are a professional and
not their peer.
• Be patient. Continue to reassure them
that you are there to help them. Inform
them that you cannot reach out to them
unless they start opening up. You will
do your best to understand them.
 HEEADSSS (Adolescent-specific
history-taking)
 HOME
- With whom do you live?
- Describe your home situation.
- When you have concerns/problems, to whom do
you confide?
- Are there any problems within your family that
directly or indirectly concerns you?
 EDUCATION/EMPLOYMENT
- Are you studying/working?
- How are things for you at school/work?
- Are you having failures or problems?
- How is your relationship with teachers, fellow
classmates or employees?
- Have you experienced bullying in school?
Elsewhere?
 EATING
- Are you happy with the way you look or would
you like to be different in some way?
- On a normal day, how many meals do you have?
What do you eat?
- Do you spend time thinking about ways to be
thin?
- Has somebody pointed out that you have gained
weight or lose weight?
 ACTIVITY
- What do you do in your free time?
- Whom do you spend your time with?
- Do you participate in sports activities in school or
community?
- Do you exercise regularly?
- How often do you use internet/computer?
 DRUGS
- Have you ever used tobacco? Alcohol? Other
substances?
- If so, are you using them currently?
- How much?
- How heavily?
 SEXUALITY
- Do you have any concerns regarding your body
changes?
- Have you ever had sex?
- Did you want to have sex or were you forced to
have sex?
- Are you sexually active now?
- Do you protect yourself from infection or
becoming pregnant or getting someone pregnant?
 SAFETY
- Do you feel safe at home? At work? At school?
In your neighborhood?
- If NO, what makes you feel unsafe?
- Do you wear a seatbelt when riding a car? A
helmet when riding a motorbike?
- Has anybody touched or hurt you in ways that
you do not want?
 SUICIDE
- Are you stressed? Sad or depressed in any way?
Are you able to cope with the situation?
- Have you ever thought of hurting yourself or
ending your life?
 Take their history: ASK
 Using the questions listed under each algorithm
ask them why they have come to you. Go beyond
the ‘presenting need or problem’ to ask if they
have other needs and problems.
 Use the dialect that they are comfortable with.
 Be alert for a hidden agenda. Adolescents may
present with vague complaints or symptoms that
are not consistent with the extent of their
complaints.
 If dealing with very sensitive issues, avoid asking
directly on this issue until later.
 Prioritize issues depending on the urgency and
seriousness of the complaints.
 Conduct the psychosocial assessment or the
HEEADSSS history.
 Look for Signs/Symptoms
 Always explain to the patients what you are
going to examine, before you do it. Seek their
permission before carrying out the procedure.
 Wash your hands before and after examining the
patient.
 If you are of opposite gender from the
adolescent, always request that the adolescent
have a chaperone in the room.
 Give the adolescent privacy to undress or change
into a gown (if needed).
 Continue to talk and to reassure them if your
findings are normal. Use this opportunity to
educate the adolescent about normal growth and
development.
 Any abnormal findings should be pointed out and
questions pertinent to this may be asked.
 Manage the condition
 Discuss with the adolescent what your plans are.
 Always give the adolescent a chance to clarify and ask
questions.
 Make sure the adolescent patient understands what
your plans are.
 Make the adolescent summarize and repeat what they
heard from you.
 Discuss with the adolescent what information he/she
would want to be discussed with the parent or
guardian.
 If there are issues that are important to discuss with
the parent/guardian, the patient must understand the
reason why it should be discussed.
 Follow-up of Patients
 Explain arrangement for follow-ups. In case you
have to refer cases that you cannot handle,
always write a referral note.
 Instruct the adolescent and family to secure the
referred facility their evaluation
 Give the patient a date when he/she should come
back.
 Make sure the patient agrees to the date. You
may also ask what may keep him/her away from
the appointment.
 If there is a problem, let the adolescent state how
he/she will be able to keep the appointment.
Sometimes, it would be necessary to inform the
parent/guardian who can always remind the
adolescent.
 If necessary, ask the patient’s contact numbers
and make sure he/she agrees to receive calls or
reminders from your office.
 Write name and contact number in appointment
books.
 Let the adolescent provide ways to have them
easily contacted especially if they do not want
their parents to know.
 Give the adolescent the office contact numbers
where they can call for emergencies and to
confirm appointments.
 Referrals
 Refer the adolescent to any agency you think can
manage his/her case (City Health, CSWD, CPH,
PNP, others)
 Write into your referral note any pertinent
information you have gathered from your
interview/consultation.
 Instruct the adolescent clearly of what he/she
needs to do (what, who, where, when, how)
 Pro-active Case Finding
 Usually, adolescents are not eager to present
themselves for evaluation due to whatever
reasons (fear, shy, distrust towards provider), thus
Pro-active Case Finding is a doable option to
detect possible risky behaviours among
adolescents.
 Quarterly, Semi Annual, Annual “Kamustahan”
Sample Form
Questions?
 Activity 2: Conduct of HEADSSS
Assessment Simex
 SCENARIO:
- A co-teacher referred a student/s to your office for
HEEADSSS Assessment and management as he/she
noticed some risky behaviours.
 INSTRUCTIONS:
- Decide upon your group the roles of each member
(Problematic student, Service Provider, Co-Teacher,
etc.), depending on the case assigned to your group
- Present via role play on what you would do with the
assigned scenario.
 Activity 2: Conduct of HEADSSS
Assessment Simex
 1. Teenage Pregnancy (Couple)
 2. Adolescent victim of bullying by classmates
 3. Adolescent victim of Sexual Abuse (happened at school)
 4. Adolescent with Failing Grade
 5. Adolescent with Suicidal Ideations
 6. Adolescent with compulsive behaviours (cutting classes,
drug use, smoking, alcohol)
 7. Adolescent with Internet Addiction
 8. Adolescent who has frequent absences at school because
of family issues (financial)
 References
 Adolescent Job Aid Manual 2009
 World Health Organization :
https://www.who.int/news-room/fact-sheets/detai
l/adolescents-health-risks-and-solutions